[Histonet] In House Labs in WSJ

Davide Costanzo pathlocums <@t> gmail.com
Tue Apr 10 19:30:59 CDT 2012

> > Less screening = fewer biopsies = less revenue = less prostate cancers
> caught early = more deaths to prostate cancers.
> Would you not agree?
According to the study referenced earlier, just the opposite is true.
Increased utilization arising from in-house laboratories has proven to be
less effective, and much more costly than their traditional counterparts.
No benefit to the patient at all, actually a detriment. The best results
still come from outfits owned and operated by pathologists and/or
hospitals, and at a significantly lower cost.

> And for all those advocating closure of private labs, do you also feel the
> same way about private pathologist owned labs who reep the benefits of
> getting all the out PT work from affiliated physicians while they also get
> a fee to serve as medical directors of hospital labs and get the pc portion
> of hospital work of which they can order as many test they want so they get
> the pc portion while the hospital gets the tc and all the big bills
> associated with doing the test making it hard on tax payer as well because
> so much in a hospital is already subsidize by the gov.
Private labs outside of the hospital, owned by pathologists, do not
represent the group of non-pathologist owned in-office labs we have
discussed. There are no complaints arising over pure pathology labs,
operated by pathologists. The complaints are in reference to private labs
within a GI clinic, or in a urologists' office, etc.


Is what you really want is to have all pathologist as employees of the
> hospitals? And have the hospital bill global.
Doctors in hospital settings are very rarely employed by the hospital, with
the exception being academia. In most cases, the pathology group handles
their own billing for professional fees. Just like radiologists, surgeons,
anaesthesiologists and most others working in a hospital are not employed
by that hospital.

> And a few walmart like reference labs
> I'm just curious as to the exact position of some on here.
> Thanks
> Kim
> Sent from my iPhone
> On Apr 10, 2012, at 2:39 PM, "Morken, Timothy" <
> Timothy.Morken <@t> ucsfmedctr.org> wrote:
> > Not surprising since our health care system is biased to pay for tests
> and treatments, not results. On top of this there are serious questions as
> to whether the PSA screening that leads to biopsies is useful in the long
> term. There is a recommendation out there to stop PSA screening for most
> men since it is largely  non-specific. That test is what leads to the
> biopsies. Less screening = fewer biopsies = less revenue.
> >
> > Tim Morken
> >
> >
> >
> > -----Original Message-----
> > From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:
> histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Daniel Schneider
> > Sent: Tuesday, April 10, 2012 11:22 AM
> > To: Histonet
> > Subject: [Histonet] In House Labs in WSJ
> >
> > The Wall Street Journal served up a timely article for us.
> > You'll see both sides of the argument below. One side is right.
> >
> > DLS
> >
> > April 9, 2012, 7:22 p.m. ET
> > Prostate-Test Fees Challenged
> >
> > Doctors in urology groups that profit from tests for prostate cancer
> order more of them than doctors who send samples to independent
> laboratories, according to a study Monday in the journal Health Affairs.
> >
> > The study found that doctors' practices that do their own lab work bill
> the federal Medicare program for analyzing 72% more prostate tissue samples
> per biopsy while detecting fewer cases of cancer than counterparts who send
> specimens to outside labs.
> >
> > Hiring pathologists boosts revenue for a practice and creates a
> potential incentive to increase the number of tests ordered, said Jean
> Mitchell, a Georgetown University economist and author of the study.
> >
> > That fewer cancers were detected-21% versus 35% for those sent to
> external labs, according to the study-suggests "financial incentives"
> > may play a role in decisions to order the tests, Ms. Mitchell said.
> >
> > Some urologists said the research doesn't necessarily indicate financial
> motives. Urologists in larger group practices that have in-house
> pathologists may be more aggressive in testing because they seek to catch
> cancer earlier, said Steven Schlossberg, a Yale urologist who heads a
> health-policy panel for the American Urological Association and wasn't
> involved in the research. Also, Dr. Schlossberg noted, the figures, which
> cover 36,261 biopsies from 2005 through 2007, are five years old.
> >
> > The study was financed by the College of American Pathologists and the
> American Clinical Laboratory Association. It is the last salvo in a turf
> war between laboratory companies and physician groups that have opened
> their own labs to conduct tests.
> >
> > Regulators and economists scrutinizing the growing costs of health care
> have targeted a range of related activities by doctors, known as
> self-referrals.
> >
> > Although a set of 1990s-era laws, named for their proponent, Rep. Pete
> Stark (D., Calif.), ban doctors from referring patients to most companies
> in which they have a financial interest, urology groups can enter the
> pathology business because of an exemption for certain services performed
> within physicians' offices. The pathologists and other groups are lobbying
> Congress to end the exemption.
> >
> > At issue in the study is a quirk of billing for lab procedures. Labs get
> paid based on the number of jars used to hold specimens from a prostate
> biopsy. Doctors can choose to put several specimens in one jar or put each
> in its own jar, potentially boosting lab fees, which averaged about $104 a
> jar in 2010, according to the study.
> >
> > Urologists in practices with in-house pathologists sent 11.4 jars per
> biopsy for testing versus 5.9 jars per biopsy for other doctors in 2005.
> >
> >
> > Some doctors say that separating the samples can help them better map
> any cancer.
> >
> > In addition, urologists in recent years have been taking more samples
> during a biopsy to better identify the location of any cancer, said John
> Hollingsworth, an assistant professor of urology at the University of
> Michigan. The standard number of samples taken doubled to 12 over the last
> decade, he said.
> >
> > The Health Affairs study's conclusions are "largely around billing
> practices, not around clinical practices," said George Kwass, a pathologist
> based in Massachusetts and board member of the College of American
> Pathologists. Urologists who team up with pathologists appear to bill more,
> he said, leading to potential waste.
> >
> > Urology groups are consolidating, and increasingly moving into the
> pathology business. One large practice based on New York's Long Island,
> Integrated Medical Professionals, opened its lab in 2010 to control costs
> and because doctors encountered errors in outside test results, said the
> group's chairman, Deepak Kapoor.
> >
> > "We don't make a fortune on pathology," Dr. Kapoor said.
> >
> > But lab businesses are seeing revenue vanish. Texas pathology group
> ProPath stopped getting prostate tissue from large urology groups more than
> four years ago, said executive director Krista Crews, when these clients
> began doing lab work in-house. The group still gets referrals from small,
> one and two-doctor practices, she said.
> >
> > Large laboratory companies are worried about the trend, too. Quest
> Diagnostics Inc. DGX -2.52%said in its latest annual filings that if
> physicians, including urologists as well as gastroenterologists and skin
> and cancer doctors, continued to "internalize" testing services, it could
> reduce the company's sales.
> >
> > Write to Christopher Weaver at christopher.weaver <@t> wsj.com
> >
> > Copyright 2012 Dow Jones & Company, Inc. All Rights Reserved
> >
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*David Costanzo, MHS, PA (ASCP)*
Project Manager
*Blufrog Path Lab Solutions*
9401 Wilshire Blvd. Ste 650
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